CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Temporary expansion of telemedicine and telephone-only services

Governs reimbursement, coverage, and billing requirements for telemedicine and telephone-only medical services provided by Neighborhood participating providers during the COVID-19 emergency period; applies to Medicaid, Commercial, and INTEGRITY lines of business.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTemporary expansion of telemedicine and telephone-only services

Policy CodePolicy N/A

Change TypeTemporary telemedicine expansionmultiple operational and billing updates

Effective DateMar 18, 2020

Next Review DateN/A

Key ActionPrior authorization requirements are waived for the telemedicine/telephone-only services outlined in this policy.

SourceLink

POLICY UPDATE CHANGES

Prior authorization requirements are waived for the telemedicine/telephone-only services outlined in this policy.

Neighborhood will reimburse telemedicine/telephone encounters at 100% of the in-office allowable for any clinically appropriate, medically necessary covered health service.

Commercial plan member cost share will be waived for services outlined in this temporary policy.

Place of Service (POS) 02 must be used and claims must include modifier 'CR' to indicate catastrophe/disaster related services.

100%reimbursement parity

90 daysclaim submission timeframe

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Telemedicine and Telephone-only Coverage Criteria

Coverage criteria and permitted providers

Telemedicine/telephone-only services are covered when ALL of the following are met and when billed by authorized provider types.

ALL of the following

Patient must be present/participate at time of service
Service must meet key components/requirements equivalent to face-to-face interaction
Service must be medically necessary and covered under the member's benefit plan
Service must be within the provider's scope of license
Permanent record of the communication must be documented and maintained in the patient medical record

ALL of the following

Primary care physicians
All medical specialists (MD, DO, NP, PA)
Optometrists
Doctors of Podiatric Medicine (DPM)
Chiropractors (DC)
Lactation consultants
Physical, occupational and speech therapists

ALL of the following

Neighborhood will reimburse telemedicine/telephone encounters at 100% of the in-office allowable for clinically appropriate, medically necessary covered health services
Prior authorization requirements are waived for the telemedicine/telephone-only services outlined in this policy

ALL of the following

Documentation requirements for telemedicine/telephone-only services are the same as for any face-to-face encounter
Neighborhood reserves the right to audit medical and administrative records to verify nature of services, medical necessity, appropriateness of telemedicine/telephone delivery, and level of E/M coding

Coverage exclusions

The following services and scenarios are excluded from coverage via telemedicine/telephone-only.

ANY of the following

Services rendered through email, text, fax, or patient portal
Telemedicine that occurs the same day as a face-to-face visit when performed by the same provider for the same condition
Patient communications incidental to E&M services (e.g., reporting test results, provision of educational materials)
Administrative matters (scheduling, registration, billing updates, reminders, refill requests, referrals, ordering diagnostic studies, patient-completed medical history)
Any telemedicine/telephonic encounter conducted by office staff, RNs, LPNs, etc.

Claim Coding and Submission Requirements

Required claim codingmixedCovered

POS 02	Place of Service code indicating telemedicine
Modifier 'CR'	Catastrophe/Disaster Related modifier required on claims

inv-04: Claim submission timeframe

Claim submission timeframeProviders must submit complete claims for payment within 90 days of the date services are provided to members.

Place of Service requirementPlace of Service (POS) 02 must be on the claim to indicate the service was delivered via telemedicine/telephone-only.

Required claim modifierClaims must include modifier 'CR' (Catastrophe/Disaster Related).

Billing relationshipTelemedicine is not considered a distinct benefit and is covered as a place of service.

Operational Actions for Providers

Prior Authorization

Prior authorization waived for telemedicine/telephone-only services

Prior authorization requirements for services covered under this temporary telemedicine/telephone-only policy are waived; providers do not need to obtain prior authorization for those services.

Definitions: Telemedicine / Telephone-only

inv-06: Telemedicine/telephone-only

DefinitionTelemedicine/telephone-only services: medical services provided via telemedicine or telephone during the COVID-19 pandemic as temporarily expanded by Neighborhood in accordance with Rhode Island Executive Orders and OHIC guidance.

Applicable scopeApplies to Neighborhood participating providers for all lines of business (Medicaid, Commercial, and INTEGRITY) for dates of service on or after March 18, 2020.

Billing noteTelemedicine is billed using Place of Service (POS) 02 to indicate delivery via telemedicine/telephone-only.